The authors describe a group of patients with initially successful dacryocystorhinostomy surgery with late recurrence of epiphora. The causes of late failure and its management are documented.
A retrospective chart review of primary dacryocystorhinostomy cases was undertaken. Inclusion criteria were an initially successful primary dacryocystorhinostomy and recurrence of symptoms at least 12 months after surgery, together with clinical evidence of impaired lacrimal drainage. Patients' subsequent procedures were detailed and outcomes determined.
Thirteen cases of late failure of dacryocystorhinostomy were identified (8 of 1,158 surgeries by A.A.M., 4 of 378 by D.S., 1 patient whose initial dacryocystorhinostomy was done by another surgeon). Most patients were female (85%), and average age at initial surgery was 57.9 years. Most cases had nasolacrimal duct obstruction as the initial cause of epiphora (10 of 13 or 76.9%). The mean time to recurrence of symptoms after initial surgery was 46.9 months (range, 15–97 months). Pre- and intraoperative findings at second lacrimal surgery identified the cause of epiphora in late failure to be common canalicular obstruction in 11 of 13 patients (84.6%). Eleven of the 13 patients avoided repeat dacryocystorhinostomy, instead undergoing probing (with or without common canalicular membranotomy/membranectomy) and silicone intubation. Twelve of the 13 patients (92.3%) remained asymptomatic at final follow-up (range, 4–131 months).
Although late failure after primary dacryocystorhinostomy is rare, this newly described group appears to be a distinct clinical entity, with lacrimal system obstruction often occurring at the common canaliculus. In the large majority of cases, a less invasive surgical solution than repeat dacryocystorhinostomy is effective in resolving symptoms.
Late failure of dacryocystorhinostomy is usually due to a distal common canalicular obstruction, regardless of the initial level of obstruction, and can often be managed with probing and intubation alone.
*Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne; and †Oculoplastics Department, Royal Adelaide Hospital, Adelaide, Australia
Accepted for publication January 4, 2010.
Presented at the Congress of the Royal Australian and New Zealand College of Ophthalmologists, Melbourne, Australia, November 2008.
None of the authors have any financial interest related to this manuscript.
Address correspondence and reprint requests to Alan McNab, F.R.A.N.Z.C.O., M.D., Orbital, Plastic and Lacrimal Clinic, The Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia. E-mail: email@example.com